Endocrine dysfunction has not been prominent in HIV infection. Nonetheless, all glands of the endocrine system may be infiltrated with opportunistic infections or malignancies or may be affected by drugs used to treat HIV-related disorders.…

A wide variety of cardiac abnormalities have been reported in HIV-infected patients, including ventricular dysfunction myocarditis, pericarditis, endocarditis, and arrhythmias. Most often, cardiac involvement is clinically silent and is noted as an incidental finding at…

Renal disease associated with HIV infection may present as fluid-electrolyte and acid-base abnormalities, acute renal failure, coincidental renal disorders, or a glomerulopathy directly related to underlying HIV infection, the so-called HIV-associated nephropathy (HIVAN). Originally observed…

Infection with the human immunodeficiency virus type I (HIV) is a multisystem disease. Manifestations of pulmonary, gastrointestinal, neurologic, hematologic, and oncologic disease are…

A signature abnormality of human immunodeficiency virus (HIV) infection is the decline in the number of CD4 lymphocytes over time. However, other cytopenias also are seen in advanced disease, with anemia reported in 60%,…

The incidence of Hodgkin’s disease has been estimated to be up to 18-fold greater in HIV-infected individuals compared to the HIV-seronegative population. In patients with HIV infection and Hodgkin’s disease, the clinical presentation usually includes…

B-cell lymphoma frequently occurs in immunosuppressed individuals. Genetic disorders of the immune system such as Wiskott-Aldrich syndrome, as well as immunosuppressive therapy used in organ transplantation, are associated with malignant transformation of B cells and…

Kaposi’s sarcoma is the most frequent neoplastic manifestation of HIV infection and is one of the CDC criteria that define an HIV-infected individual as having AIDS. AIDS-associated KS more frequently is seen among homosexual or…

Suppression of leukocyte or erythrocyte production can be a limiting factor in treating HIV infection or its complications. This problem has become less limiting with newer antiretroviral therapies and better control of HIV-1. However,…

Anemia increases in incidence in HIV-infected patients as their degree of immune dysfunction worsens. The anemia is usually normochromic and normocytic with iron studies that are either normal or indicative of chronic disease. Occasionally the vitamin…

Neutropenia occurs in the HIV-infected patient in concert with decreases in other cell counts with progressive deterioration of the immune system. In addition to neutropenia, neutrophil dysfunction has been reported in AIDS. The extent to which…

Thrombocytopenia may be a presenting laboratory finding in an otherwise asymptomatic HIV-infected person. HIV infection should be considered in the differential diagnosis of thrombocytopenia, and the history should include questions regarding risk factors for infection. Clinically…

Counseling HIV-infected patients can present great challenges to their physicians. Many HIV-infected persons enter the physician-patient relationship with significant emotional distress and numerous complicating circumstances. These complicating circumstances can include issues of sexual orientation and sexuality,…

As HIV infection progresses, it creates increasing immunosuppression, resulting in a predisposition to complicating opportunistic infections and neoplasms. The pattern of these complications can be predicted by following a patient’s absolute CD4+ lymphocyte…

With improving longevity for HIV-infected persons receiving antiretroviral treatment, but also acknowledging the finite durability of each regimen and a limited number of regimens, the optimal strategy for the use of antiretroviral therapy is crucial…

The clinical approach to the HIV-infected patient should be guided by several important principles. First, it is important to establish the degree of immunosuppression in every patient through the history and physical…

Treatment advances in human immunodeficiency virus (HIV) disease have dramatically changed the management of chronically infected persons. Advances in three areas have…

We are just beginning to learn about the immune reconstitution attained when HIV-infected patients attain substantial viral suppression with highly active antiretroviral therapy. For the first few months of therapy, patients have…

Although a complete discussion of the therapy for the pregnant HIV-infected patient is beyond the scope of this section, it is worth highlighting several important issues. First, it is generally accepted…

The substantial recent developments in AIDS therapy and in our ability to monitor viral dynamics have led to a major shift in the thinking about HIV therapy. Several panels…

Starting in the early 1990s, a number of structurally unrelated non-nucleoside compounds were discovered to be potent non-competitive inhibitors of HIV reverse transcriptase. These compounds share the property of having highly specific activity…

The second enzyme of HIV to be successfully targeted was the viral aspartyl protease. HIV produces the structural proteins of the viral core, as well as the integral viral enzymes, as Gag and Gag-Pol polyproteins…

Before going on to discuss specific recommendations for therapy, it is of value to review the drugs that are presently available for the treatment of HIV. As noted earlier,…